One-day cognitive-behavioural therapy self-confidence workshops for people with depression: randomised controlled trial.

BACKGROUND: Despite its high prevalence, help-seeking for depression is low. AIMS: To assess the effectiveness and cost-effectiveness of 1-day cognitive-behavioural therapy (CBT) self-confidence workshops in reducing depression. Anxiety, self-esteem, prognostic indicators as well as access were also assessed. METHOD: An open randomised controlled trial (RCT) waiting list control design with 12-week follow-up was used (trial registration: ISRCTN26634837). A total of 459 adult participants with depression (Beck Depression Inventory (BDI) scores of ≥ 14) self-referred and 382 participants (83%) were followed up. RESULTS: At follow-up, experimental and control participants differed significantly on the BDI, with an effect size of 0.55. Anxiety and self-esteem also differed. Of those who participated, 25% were GP non-consulters and 32% were from Black and minority ethnic groups. Women benefited more than men on depression scores. The intervention has a 90% chance of being considered cost-effective if a depression-free day is valued at £14. CONCLUSIONS: Self-confidence workshops appear promising in terms of clinical effectiveness, cost-effectiveness and access by difficult-to-engage groups.

Cardiac safety of repetitive transcranial magnetic stimulation in bulimic eating disorders.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is increasingly used in research. However, cardiac safety is not routinely assessed. OBJECTIVE: This study aims to investigate cardiac safety of rTMS in people with a bulimic eating disorder. METHODS: Thirty-eight people with a bulimic disorder were enrolled in a randomized sham-controlled trial. High frequency rTMS was delivered to the left dorsolateral prefrontal cortex. RESULTS: rTMS did not alter blood pressure or heart rate. CONCLUSIONS: Our findings indicated that this rTMS paradigm has no cardiac complications as assessed by blood pressure and heart rate. This adds to the emerging literature on the cardiac safety of rTMS.

Repetitive transcranial magnetic stimulation reduces cue-induced food craving in bulimic disorders.

BACKGROUND: Craving or the "urge to consume" is a characteristic of bulimic eating disorders and addictions. Dysfunction of the dorsolateral prefrontal cortex (DLPFC) is associated with craving. We investigated whether stimulation of the DLPFC reduces food craving in people with a bulimic-type eating disorder. METHODS: Thirty-eight people with bulimic-type eating disorders were randomly allocated to receive one session of real or sham high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC in a double-blind procedure. Outcome measures included self-reported food craving immediately after the stimulation session and frequency of bingeing over a 24-hour follow-up period. RESULTS: Compared with sham control, real rTMS was associated with decreased self-reported urge to eat and fewer binge-eating episodes over the 24 hours following stimulation. CONCLUSIONS: High-frequency rTMS of the left DLPFC lowers cue-induced food cravings in people with a bulimic eating disorder and may reduce binge eating. These results provide a rationale for exploring rTMS as a treatment for bulimic eating disorders.